Scenes from the Wating Room

They wait in a bare hallway--often for hours--for surgery. Although they have not eaten all day and there are more patients than chairs, I receive lots of happy holas.

Scenes from the Recovery Room

What would the world be like without nurses? A few words about history's most famous one: Believing she heard the voice of God calling her to service, Florence Nightingale refused marriage and decided nursing was her destiny. Although there's a lot of myth that surrounds her, my favorite fact about Florence Nightingale is that she was called "The Lady with the Lamp". I like the idea of somebody who brings light into darkness.

She got the name "The Lady with the Lamp" from a phrase in a report in the Times that said:

She is a ‘ministering angel’ without any exaggeration in these hospitals, and as her slender form glides quietly along each corridor, every poor fellow's face softens with gratitude at the sight of her. When all the medical officers have retired for the night and silence and darkness have settled down upon those miles of prostrate sick, she may be observed alone, with a little lamp in her hand, making her solitary rounds.

Scenes from the OR

The doctors, nurses and surgical technologists start work by 7 am and don't leave the hospital until 9 or 10 pm. Their tireless focus is an inspiration.

Scenes from the Sixth Floor

The 6th floor is an unused floor the hospital lends to us for the mission. The children live here with their families until the day of surgery. It is very hot, but everyone still manages to have fun.

Colombia's Motto: "Libertad y Orden"...."Liberty and Order"

When I tell my friend who works in international affairs that I am in Colombia, he sends me a report.
My friend works for the International Rescue Committee, an international humanitarian aid organization organized in 1933 by Albert Einstein to help those in opposition to Nazism. The IRC has supported numerous persecuted or displaced groups due to ethnic conflicts, war, or environmental crises.

Some Facts About Colombia:

• Population: 45 million
• Over 50% of the population live below the poverty level
• Life expectancy: 72.5 years
• Largest ethnic groups: mestizo 58%, white 20%, mulatto 14%, black 4%
• 1.4% of landowners hold 65% of total land area, while 94% of landowners hold 19%
• Highest number of trade union members murdered in the world
  
• 4 million displaced persons, 80% of which are women and children
• Women are the sole providers for half of all displaced families, while violence against women and girls has been a prolonged, conscious strategy of war by the armed groups. Children and young women are often forcibly recruited by the armed groups to be messengers, cooks, sex slaves. Children from poor areas are highly vulnerable.
• There are currently 7,000-10,000 child soldiers, with recruitment on the rise since the start of the most recent financial crisis.
  

From a February 11 Reuters article on Colombia:
"The armed groups aren't going to suffer the recession like the country's poor," Paul Martin, a United Nations Children's Fund representative in Colombia, told reporters."They're going to keep offering a million pesos to children who live and struggle more each day from the crisis and each day are more likely to accept those offers," he said.

Although there have been some improvements in security over the past couple years, the conflict is far from over. The roots of the conflict in Colombia go far back. It's the same old story: money and resources in the hand of the privileged few who do not want to share. The rich get richer, the poor get poorer, until a breaking point occurs and militias form.

Problems blocking peacemaking today:
The government can only negotiate from the established order, although it's exactly that order the guerillas have been fighting against for 40 years. The original demands of the guerillas were threefold: land reform, state administration of resources, and social reforms. But because they've employed tactics like kidnapping, child soldiers and landmines, they've undermined their legitimacy.

Drug Production
As far as drugs go, there are no indications that the methods used to impede production--like spraying coca crops from the air--have worked. The UN agency for monitoring Colombian drug production documented an increase in cultivation since 2007.
The spraying also destroys legally grown crops, and drives poor coca farmers from their homes.

From Susan Lang at ChronicleOnline, Cornell University:

Cornell graduate student Niousha Roshani works with displaced children in Colombia. Roshani, who interviewed displaced families in Colombia and then scoured many sources to assess the extent of the problem, said that warfare in that country has been displacing families for three generations.

"Displacement usually means a series of calamities for children -- homelessness, physical torture, severe trauma, malnutrition, little formal education, loss of family members and exposure to atrocities," said Roshani, an Ivory Coast citizen who has been working with Colombia's Consultancy for Human Rights and Displacement and is now planning a documentary film about Colombian child soldiers.

Nearly half of the displaced people in Colombia are children. They come from "socially invisible" Afro-Colombian and Indian populations, as well as from diverse farming communities disrupted by the country's ongoing drug war. Colombia has more displaced persons than any other country except Sudan. This includes up to 20,000 children -- many younger than 14 years of age -- who are military combatants. They make up about 25 percent of the various militias in that country.

Worldwide, some 300,000 children are bearing arms in more than 30 conflicts, according to Youth Advocate Program International. The organization reports that up to 90 percent of all casualties in these conflicts are women and children, and that from 1986 to 1996 more than 2 million children were killed and more than 6 million seriously injured in armed conflicts around the world.

I currently teach the book A Long Way Gone by Ishmael Beah, a young man who was a boy soldier in Sierra Leone. It's a wrenching tale. For more information on child soldiers, go to www.child-soldiers.org

Luis & Papa

We step outside the hospital after a long day to find Luis and his Papa pacing in front of the locked doors. Papa, a 22-year-old rice salesman, has traveled nine hours with five-month-old Luis to be here.


Although all the surgeries for the week have been scheduled, I hear Luis say, "Can't you fit adorable-little-me in somewhere?"



Dr. Fenner must have heard this, too, because within two minutes we are back in the hospital collecting information. Luis is squeezed in on Friday.

Luis & Papa head up to the sixth floor, where they will wait five days for Luis's surgery.











The next morning I go up to say hello and am surprised to meet Luis's Mama. Although she seems to care, it is Papa I always see playing with his son.
Luis has a cleft lip and palate. A cleft lip is an opening in the upper lip, which can range from a small notch up to the base of the nostril and can include one or both sides.

A cleft palate is an opening in the roof of the mouth, which can also vary in position and size. The cleft may be in the hard or soft palate, or both. The hard palate is the bony portion of the roof of the mouth that opens into the floor of the nose. The soft palate is the soft portion back by the throat.

A cleft lip and/or palate occur when the tissues of the lip and/or palate of the fetus do not fuse early in pregnancy.

There are a number of side effects that can arise from clefts, including difficulty breathing and eating. Also, the palate prevents food and liquid from going up the nose when swallowing, so when there is a cleft, food often comes out the nose.

Children with a cleft palate may also experience numerous ear infections, because fluid and air can't pass normally through the eustachian tubes, which connect the throat with the middle ear. This means fluid may become trapped behind the eardrums, creating infection and hearing loss.

Speaking clearly can also be a challenge for those with a cleft palate. Sometimes the soft palate doesn't prevent air from leaking out through the nose, which can make it sound as if they are speaking through their nose.

According to the Children's Hospital of the University of Missouri Health System, there are a number of different factors that cause clefts, including genetics, ethnic background and certain environmental and chemical exposures. About one-third of infants born with clefts have a family history of clefting.

Reported incidents of cleft lips and palates vary according to ethnicity, with Native Americans and Asians being the highest and Africans being the lowest. Some studies show the breakdown as such:

• Native Americans: 3.74/1000 births
• Chinese: 1.45/1000 to 4.04/1000 births
• Caucasians: 1.43/1000 to 1.86/1000 births
• Latin Americans: 1.04/1000 births
• Africans: 0.18/1000 to 1.67/1000 births

Back to Luis:
The Big Day is Here!!










I talk with Dr. Abraham while he performs surgery on Luis.
He says that today he operates on Luis's lip, but not his palate, because you don't want to operate too early on bone. The standard is to wait until the baby is 10 weeks to operate on a cleft lip, and 9 months for a palate.
Dr. Abraham tells me that operating on Luis's lip today will help with his feeding and speech. It will also help cosmetically, because the lips form more naturally as they heal. Clefts can become larger if you wait.
Next time he comes to Santa Marta, Dr. Abraham says, he will operate on Luis's palate. He plans for another mission April 2010.

Onto the recovery room:





Why are these nurses always honing in on my men?
















After a few hours, Luis & Papa are back to the sixth floor, in the post-op area.
















I say goodnight. It's been a long day....for everybody.

















The next day is Saturday...our last morning at the hospital. The doctors make their rounds. Dr. Abraham admires his handiwork. Although still swollen, Luis will be Hollywood gorgeous in no time. And just wait until that palate is done.

Magnifico, Luis, bebe!

All right, Mr. De Mille, I'm ready for my close-up...

Ruth Marina

I am busy moving around the hospital when one of the women from UNIMA, Marta, calls out to me.

"Lauren," she says, and that is it, because that's the end of her English. Marta and I have been hanging together for five days, laughing as tortured Spanish spouts from my mouth.

Marta points to a smiling girl who pulls up to us in a wheelchair. This girl, 11 years old, shines with beauty and light. I see arms and legs covered with scarring from burns.


"Hola, bonita," I say, and smile big at her. Marta, unsure if I get it, takes off one of the girl's slippers. There is a a badly mangled foot.


"Hola," I say again, and give her tummy a tickle. She laughs and laughs. She tells me her name is Ruth Marina.












The translator from UNIMA, Michele, comes over to us.

"Her father set the house on fire," she whispers to me. "Do you want to get her mother's story?"

I move with Michele and Ruth Marina's mother to a quiet hallway.










Ruth Marina's father had been a FARC--the Revolutionary Armed Forces of Colombia -- People's Army (Fuerzas Armadas Revolucionarias de Colombia -- Ejercito del Pueblo). Established in the 60's as the military unit of the Colombian Communist Party, it is known as a guerilla unit. Later, they started to finance themselves through the cocaine trade.

One day, Ruth Marina's mother comes home from her job at a sewing factory and finds her husband in bed with another woman. She tells him they cannot live together anymore. Her husband does not take this lightly. He proceeds to tie her wrists and knees together so tightly he breaks her bones. He then pours gasoline around the room, where their 3 babies also happen to be. He goes outside and pours gasoline around the house before lighting a match and running off.

Ten minutes later, neighbors come to help. One-and-a-half-year-old Ruth Marina and her twin sister--who is alive but I do not meet today--are immediately rushed to the hospital with the mother. Their one-month-old baby brother or sister--I do not get the gender--does not survive.

At this point in the story, tears form in the small woman's eyes, and she shakes her head. She does not go on. A profound heaviness surrounds us as we stand in the stark hallway.

A burn surgeon was scheduled to come on this trip with us, but at the last minute he was not able to come. After a moment of collecting myself, I go find the Healing the Children administrator for this trip, Steve Nargiso.


Steve meets Ruth Marina and takes some photos and information. Healing the Children is trying to set up a burn mission this upcoming October. Because finances are still uncertain, he doesn't tell the mother so as not to get her hopes up.





I give Ruth Marina all the toys I have left: sunglasses, crayons, stickers. Together, we play and giggle.

Horror stories like this are not particular to Colombia. According to the National Child Abuse and Neglect Data System, there was an estimated 3.3 million referrals of child abuse in the US in 2005---and that's just what was reported.

Gandhi said: "The greatness of a nation and its moral progress can be judged by the way its animals are treated.”

I agree, but even moreso, I feel the moral progress of humanity can be judged by the way we treat our children.





Ruth Marina, you are not alone. There are people who care. Today, we say a prayer for you.